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Zeichner S.B.,Emory Winship Cancer Institute | Ambros T.,University of Pittsburgh | Zaravinos J.,SUNY Downstate Medical Center | Montero A.J.,Cleveland Clinic | And 5 more authors.
Breast Cancer: Basic and Clinical Research | Year: 2015

BACKGROUND:Our original paper, published in 1992, reported a median overall survival after first relapse in breast cancer of 26 months. The current retrospective review concentrates more specifically on patients with first systemic relapse, recognizing that subsets of patients with local recurrence are potentially curable. METHODS:Records of 5,168 patients from a largely breast-cancer-specific oncology practice were reviewed to identify breast cancer patients with their first relapse between 1996 and 2006 after primary treatment. There were 189 patients diagnosed with metastatic disease within 2 months of being seen by our therapeutic team and 101 patients diagnosed with metastatic disease greater than 2 months. The patients were divided in order to account for lead-time bias than could potentially confound the analysis of the latter 101 patients. RESULTS:Median survival for our primary study population of 189 patients was 33 months. As expected, the median survival from first systemic relapse (MSFSR) for the 101 patients excluded because of the potential for lead-time bias was better at 46 months. Factors influencing prognosis included estrogen receptor (ER) status, disease-free interval (DFI), and dominant site of metastasis. Compared with our original series, even with elimination of localregional recurrences in our present series, the median survival from first relapse has improved by 7 months over the past two decades. CONCLUSION:The new benchmark for MSFSR approaches 3 years. © 2015, the authors, publisher and licensee libertas academica limited.

Levin R.D.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Daehler M.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Grutsch J.F.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Grutsch J.F.,University of Illinois at Chicago | And 3 more authors.
BMC Cancer | Year: 2010

Background: Preclinical studies demonstrated that small chain RNA fragments accelerate the recovery of platelets numbers in animals exposed to high doses of chemotherapeutic drugs. There is anecdotal data supporting the same application in humans. The Phase I clinical trial described here was designed to investigate the relationship between the administration of small chain RNA fragments and the recovery in platelets following Chemotherapy-Induced Thrombocytopenia (CIT).Methods: Cancer patients with solid tumors that experienced post chemotherapy thrombocytopenia with a nadir of < = 80,000 platelets/ml were eligible for this clinical trial. There were no exclusions based on ECOG status, tumor type, tumor burden or chemotherapeutic agents. Patients received a unique preparation of RNA derived from either E. coli or yeast. Ten patients per group received 20, 40, or 60 mg as a starting dose. Subjects self-administered RNA fragments sublingually on an every other day schedule while undergoing chemotherapy. The dose was escalated in 20 mg increments to a maximum dose of 80 mg if the nadir was < 80,000 platelets/ml at the start of the next cycle. Subjects were treated for three cycles of chemotherapy with the maximum effective dose of RNA fragments. Subjects continued on planned chemotherapy as indicated by tumor burden without RNA fragment support after the third cycle. Subjects kept a diary indicating RNA fragment and magnesium administration, and any experienced side effects.Results: Patients receiving E. coli RNA fragments demonstrated a more rapid recovery in platelet count and higher nadir platelet count. None of the patients receiving the E. coli RNA fragments required a chemotherapy dose reduction due to thrombocytopenia. The optimal dose for minimizing CIT was 80 mg. Conversely, subjects receiving yeast RNA fragments with dose escalation to 80 mg required a chemotherapy dose reduction per American Society of Clinical Oncology guidelines for grade 3 and 4 thrombocytopenia.Conclusions: Patients receiving myelosuppressive chemotherapy experienced an improvement in the platelet nadir and shorter recovery time when receiving concurrent E coli RNA fragments, when compared to patients who received yeast RNA fragments. These data indicate that 60 and 80 mg doses of E. coli RNA accelerated platelet recovery. Further clinical investigations are planned to quantify the clinical benefits of the E. coli RNA at the 80 mg dose in patients with chemotherapy induced thrombocytopenia. © 2010 Levin et al; licensee BioMed Central Ltd.

Grutsch J.F.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Grutsch J.F.,University of Illinois at Chicago | Wood P.A.,Dorn Research Institute | Wood P.A.,University of South Carolina | And 11 more authors.
Journal of Circadian Rhythms | Year: 2011

Background: Many cancer patients report poor sleep quality, despite having adequate time and opportunity for sleep. Satisfying sleep is dependent on a healthy circadian time structure and the circadian patterns among cancer patients are quite abnormal. Wrist actigraphy has been validated with concurrent polysomnography as a reliable tool to objectively measure many standard sleep parameters, as well as daily activity. Actigraphic and subjective sleep data are in agreement when determining activity-sleep patterns and sleep quality/quantity, each of which are severely affected in cancer patients. We investigated the relationship between actigraphic measurement of circadian organization and self-reported subjective sleep quality among patients with advanced lung cancer.Methods: This cross-sectional and case control study was conducted in 84 patients with advanced non-small cell lung cancer in a hospital setting for the patients at Midwestern Regional Medical Center (MRMC), Zion, IL, USA and home setting for the patients at WJB Dorn Veterans Affairs Medical Center (VAMC), Columbia, SC, USA. Prior to chemotherapy treatment, each patient's sleep-activity cycle was measured by actigraphy over a 4-7 day period and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire.Results: The mean age of our patients was 62 years. 65 patients were males while 19 were females. 31 patients had failed prior treatment while 52 were newly diagnosed. Actigraphy and PSQI scores showed significantly disturbed daily sleep-activity cycles and poorer sleep quality in lung cancer patients compared to healthy controls. Nearly all actigraphic parameters strongly correlated with PSQI self-reported sleep quality of inpatients and outpatients.Conclusions: The correlation of daily activity/sleep time with PSQI-documented sleep indicates that actigraphy can be used as an objective tool and/or to complement subjective assessments of sleep quality in patients with advanced lung cancer. These results suggest that improvements to circadian function may also improve sleep quality. © 2011 Grutsch et al; licensee BioMed Central Ltd.

Braun D.P.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Gupta D.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Staren E.D.,Cancer Treatment Centers of America at Midwestern Regional Medical Center
BMC Cancer | Year: 2011

Background: There are conflicting and inconsistent results in the literature on the prognostic role of quality of life (QoL) in cancer. We investigated whether QoL at admission could predict survival in lung cancer patients.Methods: The study population consisted of 1194 non-small cell lung cancer patients treated at our institution between Jan 2001 and Dec 2008. QoL was evaluated using EORTC-QLQ-C30 prior to initiation of treatment. Patient survival was defined as the time interval between the date of first patient visit and the date of death from any cause/date of last contact. Univariate and multivariate Cox regression evaluated the prognostic significance of QoL.Results: Mean age at presentation was 58.3 years. There were 605 newly diagnosed and 589 previously treated patients; 601 males and 593 females. Stage of disease at diagnosis was I, 100; II, 63; III, 348; IV, 656; and 27 indeterminate. Upon multivariate analyses, global QoL as well as physical function predicted patient survival in the entire study population. Every 10-point increase in physical function was associated with a 10% increase in survival (95% CI = 6% to 14%, p < 0.001). Similarly, every 10-point increase in global QoL was associated with a 9% increase in survival (95% CI = 6% to 11%, p < 0.001). Furthermore, physical function, nausea/vomiting, insomnia, and diarrhea (p < 0.05 for all) in newly diagnosed patients, but only physical function (p < 0.001) in previously treated patients were predictive of survival.Conclusions: Baseline global QoL and physical function provide useful prognostic information in non-small cell lung cancer patients. © 2011 Braun et al; licensee BioMed Central Ltd.

Gupta D.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Vashi P.G.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Trukova K.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Lis C.G.,Cancer Treatment Centers of America at Midwestern Regional Medical Center | Lammersfeld C.A.,Cancer Treatment Centers of America at Midwestern Regional Medical Center
Experimental and Therapeutic Medicine | Year: 2011

Vitamin D deficiency has been found to be associated with a variety of cancers, including prostate, multiple myeloma, colorectal and breast cancer. Several studies have shown vitamin D levels to have an inverse relation with cancer mortality, while others have considered it a potential risk factor. Vitamin D is believed to influence cancer prevalence, risk and survival; hence the need to assess vitamin D levels in cancer. Although numerous studies have been conducted to demonstrate vitamin D deficiency as a risk factor for cancer, relatively few have studied its prevalence. Moreover, studies estimating prevalence differ from each other, with respect to study population, sample size, study design, definition of vitamin D deficiency used and method of vitamin D assessment (with most studies limited to one particular type of cancer with relatively small sample sizes). Therefore, we qualitatively reviewed the epidemiological evidence in the oncology literature on the prevalence of vitamin D deficiency and insufficiency as measured by serum vitamin D concentrations.

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